Nurse staffing law may herald benchmarks

California became the first state to require all patient care units in hospitals to meet fixed minimum nurse-to-patient ratios. In a hospital environment where patients are sicker, and care is more complex, according to American Nurses Association (ANA) president Beverly L. Malone, "Cutting the numbers of RNs and substituting unlicensed aides for registered nurses are exactly the wrong moves." ANA's "Principles of Nurse Staffing" call for staffing decisions to be made on the basis of three sets of principles: those related to patient care, staff-related issues, and institution/organization concerns. The California legislation currently contains no specific numerical requirements. ANA's 10 Nursing-Sensitive Quality Indicators for Acute Care Settings is comprised of a series of measures that represent the nursing community's current conception of how nurse staffing levels impact patient care.